Zippers and other common causes of genital injuries studied

It can get caught in a zipper, slammed by a toilet seat or fall victim to overzealous grooming with sharp instruments.

If anyone's genitalia have been snipped, snagged or crushed hard enough to warrant a trip to an emergency room in the U.S., a team of dedicated University of California, San Francisco urologists has painstakingly documented the details in five medical journal articles published over the past year with additional studies on the way.

The first study, published in November in the Journal of Urology, looked at product-related injuries in adults and was the largest ever to look at "genitourinary" injuries, or those involving the genitals, urinary tract or kidneys. The injuries mainly involved an unfortunate encounter with a piece of sports equipment, clothing, furniture or other item.

Using the National Electronic Injury Surveillance System, which is a national probability dataset based on a sampling of U.S. hospital emergency departments, the researchers found more than 142,000 adults went to the ER between 2002 and 2010 for these types of injuries.

In December, the researchers followed with another Journal of Urology article that focused on pubic injuries that occurred during grooming. Razors are the key culprit, and researchers found the problem is clearly on the rise -- increasing fivefold during the eight-year study period.

In January, the team published an article that looked at genital injuries in children. In March, they produced a British Journal of Urology article devoted entirely to zipper mishaps, a problem immortalized in a scene from the 1998 comedy "There's Something About Mary."

An article in that same journal in June, bluntly titled "No Small Slam," examined the consequences of a toilet coming in sudden contact with the penis.

Dr. Herman Singh Bagga, a UCSF urologist and one of the main study authors, explained how the doctors became so intrigued by these injuries and why they published such a large volume of articles on the subject. This conversation was edited for space and clarity.

Q: What led you to start researching these types of injuries?

A: As urological surgeons, we deal with all sort of genitourinary problems, but generally we deal with trauma -- major trauma like accidents and other things where people end up in the emergency room and then go into surgery. But then we realized we're probably missing a lot of lower-acuity injuries and likely have a false sense of what's really going on out there.

The first step in injury prevention is to identify the injury, and that first step had never been done properly. We looked at the common injuries and the common mechanisms. We were looking for opportunities where we could make systemic change and we found a couple.

Q: What were some of the more common injuries you found?

A: We found the number one cause for penile injuries in adults was actually a zipper. It wasn't insignificant; almost 18,000 folks, both adults and children had showed up in the ER (between 2002 and 2010) with zip-related injuries. This is important for (physician) training because the next generation of doctors needs to know how to release the zipper from the penis. They need to learn mechanically how you unwedge it from the penis without damaging it.

Interestingly, an increasing problem is kids getting hit by toilet seats. The seat comes down and crushes the tip of the penis. This can also be a problem in older adults, but for children you're more in control of their behavior. We found anecdotally that kids, while being toilet trained, tend to rest the penis on the rim of toilet. So, while they're training, one thing you can do is advise a kid not to do that. There are also those slow-close toilet seats. In adults, you don't have quite as much control over their behavior, but it's important they're aware of the risk of injury.

Q: What were some of the other areas where you found opportunity for change?

A: We found there's a lot of sporting-related injuries, which is not surprising. Bicycles are the number one cause of genitourinary injuries. Usually it's someone falling and hitting the bar, so there are opportunities to make modifications. For children, you could put one of those soft tubes over the bar. That's a simple intervention that could reduce the number of injuries.